In a recent post, we discussed the importance of making the healthy choice, not just the “easy choice,” but also the happy choice. This week, we’ll touch on the power of making the healthy place, the easy and happy place.

It’s fair to say that a neighborhood fitness center serves a very different purpose than a neighborhood tavern. The former provides services to improve one’s physical health, while the latter provides services that are generally, shall we say, counter to good physical health. But despite their divergent societal purposes, I think that successful fitness centers share many characteristics with successful taverns.

They make people feel welcome. They are inclusive. And they provide a sense of belonging.

Sometimes you want to go

Where everybody knows your name

And they're always glad you came

- Theme Song, Cheers (TV Show)

“We want to be the Cheers of fitness,” says Dave Tuthill, President & CEO of Hearthstone Health & Fitness in Easton, MD, which just celebrated a wildly successful first year of operation.

But, there are no adult beverages served at Hearthstone. In fact, they only offer carefully vetted healthy food and drinks. Yet, the essence of what made a place like Cheers – the idealized neighborhood tavern featured in the 80s sitcom of the same name – so desirable is very much evident at Hearthstone.

It starts the moment a patron walks through the door. Front desk personnel warmly greet each visitor, nearly always by first name, and often with a handshake. And eye contact, that ancient old art lost in a tidal wave of handheld devices and texting, is a given.

Making your way in the world today takes everything you've got

Taking a break from all your worries, sure would help a lot

- Theme Song, Cheers

Amidst the daily, modern strains of stress and endless connectivity, sedentary behavior is often the norm, which only exacerbates the impact of stress. Hearthstone was conceived as an oasis from the bustle; not like a spa, but more like an impeccably clean living room (complete with large stone hearth fireplace, naturally) filled with new fitness equipment. The design and décor suggest stylish comfort and the staff work hard to create a “home away from home” environment.

You wanna be where you can see

Our troubles are all the same

- Theme Song, Cheers

To be sure, the members of Hearthstone run the gamut from uber-fit to struggling with obesity, so the troubles are not quite all the same in a purely physiological sense. But there is a shared belief that pursuing a healthy, physically active life can be challenging, and that the welcoming and supportive environment of Hearthstone helps overcome that challenge. Judgments are not allowed at Hearthstone, only support.

Operating a facility like Hearthstone is undoubtedly complex and nuanced, but I think I can summarize the approach quite simply:

1)Make sure that members know how much they are valued and supported

2)Do lots of listening to better understand the goals/needs/concerns of members; and

3)Keep the place really clean.

That’s it in a nutshell. Sounds like a pretty great tavern, eh?

What are some other lessons that a fitness center might learn from a tavern?

Sports-related concussions have become a significant concern in recent years. Research showing the long-term dangers of concussions and the effects of repetitive sub-concussive blows that can occur in football has parents of these athletes concerned.

Many sports teams are partnering with sports medicine programs and hospitals to perform baseline concussion testing for the athletes. These tests are critical if an athlete suffers a concussion.

Simple physical exam tests can be unreliable for determining if the athlete’s brain has completely returned to normal. Doctors can compare the results of baseline neurocognitive testing performed before the season to the results from the second test after a brain injury. Only when the results have returned to their baseline values should doctors clear that athlete to play.

Recent media reports have described professional athletes admitting that they intentionally perform poorly on baseline tests to be cleared for play sooner after an injury. Many team doctors have heard similar stories among high school and college athletes.

A study presented recently at the American Orthopaedic Society for Sports Medicine's Annual Meeting suggests that sleep could be another concern when athletes take these baseline neurocognitive tests.

Jake McClure and others at Vanderbilt University Medical School gathered the results of baseline concussion testing for 3,686 high school and college athletes with no prior history of concussions. They categorized the athletes into three groups based on the amount of sleep each athlete got the night before the test – less than seven hours, seven to nine hours and greater than nine hours.

The researchers found that three scores seem to be affected by a lack of sleep. The athletes who obtained less than seven hours of sleep had poorer scores for reaction time, verbal memory and visual memory.

The relationship between sleep and neurocognitive performance deserves more study. Is a lack of sleep just the night before the test more harmful than chronic sleep deprivation? Do other physical or emotional issues that might affect sleep impact the scores? It seems clear, though, that parents, coaches and doctors should encourage athletes to try to sleep well the night before these tests, at least.

“Understanding an athlete’s total health picture, including sleep patterns may help lead to more accurate concussion testing and allow for fewer individuals to be returned to play earlier than necessary,” McClure concluded.

We have a long way to go to make serious progress in preventing concussions. However we can decrease the chance of recurrent concussions. We can also lessen the possibility of worse brain injuries occurring from second blow before the athletes’ brains have returned to normal.

Baseline concussion testing is critical to those efforts. Making these tests available to all teams, leagues, schools and athletes is the first step. Getting athletes to take them seriously and perform as well as possible is another vital step. Now we know that we should encourage these kids to sleep enough as well.

It’s time for that weekly staff meeting which can range from one to many hours of conversation, reporting, strategizing - and most importantly - a lot of sitting.Deciding to become a wellness champion, you suggest a “Moving Meeting” to get some physical activity, which may also increase natural vitamin D and spark creativity with coworkers.In addition to providing more movement throughout the workday, you have also helped to lower your coworkers’ risk of cardiovascular disease and other causes of mortality by reducing their sedentary time.

Moving Meetings, among many other wellness strategies, can become a part of your worksite’s culture.Employee wellness programs are gaining speed in corporate America, providing benefits to employers (e.g. reduced health insurance costs), and to employees, (e.g. increasing access to necessary health screenings).The latest data shows an employer’s Return on Investment (ROI) to be $6 for every $1 spent on workplace wellness.In a recent research report sponsored by the U.S. Department of Labor and the U.S. Department of Health and Human Services and conducted by RAND Health, it was noted that almost half of employers in the U.S. are offering wellness program initiatives.The report also noted that meaningful improvements were seen in exercise frequency, smoking, and weight control for wellness program participants compared to nonparticipants.

Within the Affordable Care Act (ACA), employee wellness programs are supported as a means of reducing chronic illness by improving health and controlling health care costs while protecting consumers from unfair practices.Final rules regarding employee wellness programs, which support and further outline guidelines for two types of wellness programs, were released in May 2013 and become effective in January 2014.These include participatory wellness programs that are available to all employees without requirement to meet a health-related standard and health-contingent wellness programs where a reward is offered to individuals who meet a health-related standard.The final rules go further for health-contingent wellness programs outlining five additional requirements to limit health status discrimination.Click to read the entire final rules regarding employee-based wellness programs.

In regards to providing wellness for all employees the final rules consist of terminology such as “reasonably designed”, “uniform availability”, and “reasonable alternative standards.”These phrases protect consumers from being discriminated against in relation to health status, and allow employees with medical conditions, which may or may not include employees with disabilities, to equally receive wellness-related rewards.It is also important to note that the final rules do not override other laws such as the Americans with Disabilities Act (ADA), which requires reasonable accommodations for employees with known disabilities to allow them to participate.Employees with disabilities are more likely than their coworkers to have secondary health conditions; therefore adding a level of inclusion to worksite wellness programs is both the smart and right choice.

Here are some tips to get you started:

Include employees with disabilities in wellness program planning either on the wellness committee or working closely with the wellness coordinator to ensure program activities are accessible and meet the needs of all employees.

Create inclusive marketing materials by using images of people with and without disabilities, person-first language, and inclusive terminology such as “Moving Meeting” and “Run.Walk.Roll 5k”.

Ensure accessibility of marketing materials by providing a variety of formats such as audio, picture-based, large print and accessible electronic formats.

Provide relevant incentives for employees with a variety of abilities.

Create accommodations when appropriate.For example, a walking program encouraging 10,000 steps a day may not be appropriate for all employees.Instead allow employees to track steps or movement throughout the day and encourage an increase in activity.

Provide a map of accessible routes to increase physical activity throughout your worksite’s campus instead of only promoting the stairs.

Consider a smoke-free workplace policy which will impact all employees, but especially employees with disabilities, since they are more likely to smoke cigarettes (25.4% vs. 17.3%).

Include healthy options in vending machines and ensure they are accessible to employees who may use a wheelchair.

The culture of a worksite can make or break participation in employee wellness programs.To reap the benefits both for employers and employees, consider creating a culture of inclusion, welcoming all employees to improve their health.